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Requested and Pending Hearings SOP

Tools #

Hand Off: Use Hearings Hand Off for all Hearing Search, Hearing Manual, FAQ and User Guide

 

Resolving the Issue #

When a participant contacts FSD regarding an adverse action, staff should discuss the facts regarding the rejection, closing or reduction of benefits with the participant and try to resolve the issue following first contact resolution procedure.

    • Discuss the action notice with the participant, explaining policy and why the action was taken. Usually, an agreement can be reached after giving the participant a clear understanding of why the action was taken.
    • If participant is undecided if they want to request a hearing, staff should ask if they would like the IM-4 Hearings Information brochure mailed to them.
    • If an agency error is found and/or changes the participant is reporting, action should be taken at the time of discovery.

 

Hearing Requested #

A request for a hearing is any clear expression, either verbally or written, by the participant, the participant’s authorized representative or legal representative that the participant chooses to appeal a FSD decision or action.

    • Staff no longer need to:
        • Complete the paper IM-85, but the IM-85 form is still available for participants if requested.
        • Attach an agency action notice.
        • Scan the documents to the IMHU worksite.
    • All requests not received by phone or in-person, the original request and any supporting documentation should immediately be scanned and added to the ECM.
    • To submit a hearing request staff must navigate to the Hearing site in the FSD Worksite, New Worksite, Hearings.

Grievable Reasons for Requesting a Fair Hearing:

    • Include, but not limited to:
        • The participant was denied the right to apply.
        • FSD does not inform the participant of a decision on an application within a reasonable length of time.
        • The participant’s application was rejected.
        • The participant’s amount of benefits and/or services, including changes in level of care, was reduced or terminated.
        • The participant requests an increase in benefits, and the request is denied.
        • The participant’s requests to add one or more individuals to their case is denied or not acted upon within the required time.
        • The form of payment is changed to a protective payee, vendor, or two-party payment.
        • The participant requests an increase in the spousal share upon application for vendor benefits by the institutionalized spouse, or the participants requests an increase in the monthly allotment to a community spouse or dependent.
        • The participant’s request for a hardship waiver from a transfer of asset penalty is denied.
        • The participant’s request for restoration of lost benefits is denied.
        • The participant is subject to collection or recoupment of an overpayment.
        • The participant’s request for a covered Medicaid service is denied.
    • Staff must not limit or interfere with the freedom of the participant to request a hearing.

It is the responsibility of the staff member taking the customer’s hearing request to place the HOLD on the case.

    • When the customer is requesting a hearing for a benefit reduction or closing action that is still in AABR/AACL- AUP status, discuss the HOLD option with the customer. The HOLD option allows the participant to continue at the amount authorized immediately before the adverse action, unless other factors that were not contested result in a benefit change.
        • FAMIS: If the customer requests a hold be placed on the pending reduction or closing, staff will go to ACTRES and refer to Changing An Adverse Action Status to place the HOLD on the case.
        • MEDES: If the customer requests a hold be placed on the pending reduction or closing, staff will follow steps in Adding New MO Override Eligibility Evidence to place an override on the participant’s case.
        • Participants can request that continued benefits not be issued during the hearing process and no HOLD will be placed on the case.
    • NOTE: If the hearing decision affirms the FSD action, FSD will establish a claim for any benefits the EU or household was overpaid while waiting on the hearing decision. It is important that the participant understands this before the HOLD is placed.

Comment on program specific EUMEMROL/FM3Z-FAMIS or HoH Person Page-MEDES when a customer requests a hearing and include the following information:

    • Name of the person requesting the hearing.
    • Date the hearing was requested.
    • Why the hearing was requested.
        • Do not include specific information related to medical conditions/MRT decisions, Medical or MRT is sufficient.
    • Date the Hearing Request Handoff was completed.

 

Time Limits for a Hearing Request #

    • FSD must receive the participant’s request to appeal an action, decision, or current level of benefits:
        • Within 90 calendar days from the date of the FSD action notice.
        • Any time within a Food Stamp certification period if an EU disagrees with their current amount of benefits.
        • Within 90 days of the date of the denial of restored Food Stamp benefits and the benefits were lost less than a year before the date of the request for restoration.
    • A participant may request a fair hearing any time the participant disagrees with a decision, action or failure to act by FSD, or the amount of benefits.
        • FSD staff must accept all hearing requests, and Submit Hearing Referral.
        • The Administrative Hearings Unit (AHU) may reject or dismiss an appeal received outside the 90-day limit.

 

Voluntary Withdraw from Hearing #

    • A participant may voluntarily withdraw their Application for State Hearing.

 

When not to Submit a Hearing Request #

    • The customer is requesting a hearing on a non-grievable action.
        • If an action in FAMIS is in RTA status, that action is not grievable.
        • If an action is not finalized in MEDES, that action is not grievable.
    • The customer is requesting a hearing on a decision from a prior hearing:
        • Participant dissatisfied with a hearing decision may appeal to the Circuit Court of their residence county. The participant begins the process by:
            • Contacting the AHU within 90 days of the date of the hearing decision.
            • The participant appeal for review to the Circuit Clerk must include:
                • The issue being appealed.
                • How the participant is aggrieved by the decision.
                • The request for relief the participant desires.
            • FSD is not required to assist the EU in preparing for the judicial appeal.
                • When the affidavit for appeal has been properly executed and returned to the DLS Office of General Counsel, they are certified along with a transcript of the hearing proceedings and sent to the Circuit Court of the county in which the participant resides.
                • The Circuit Court tries the case on the record of the proceedings.
                • The Circuit Court’s decision is based on whether the participant was given a fair hearing and whether the decision was arbitrary or unreasonable as a matter of law. If the decision is favorable to the participant, the Court will remand the proceedings for re-determination of the issues to the Director of FSD.

 

Processing Task on a case Pending a Hearing #

    • Staff will continue to act on all changes reported by the participant in a timely manner and correctly adjust benefits.
        • FSD staff will enter a comment on EUMEMROL/HoH Person Page indicating the reason a hearing was previously requested so that no action is take until the completion of the hearing and the changes reported on the case that the worker entered in the system.
            • FSD will provide advance notice of adverse action if benefits are reduced or terminated for other reasons while the hearing decision is pending.
    • No action directly relating to the issue of the hearing can be taken until:
        • The final hearing decision is made.
        • The issue is resolved with changes processed and the participant withdraws the hearing request or FSD rescinds (See FSD Policy Manual – 17.3 Pre-Hearing Case Reviews, sub-sections 17.3.2 and 17.3.3).
        • The Snap certification period expires.

 

Non FSD Hearing Requests #

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